The Yung percutaneous mastoid vent: a medium-term follow-up study.

BACKGROUND: I designed a percutaneous mastoid vent to provide permanent ventilation to the middle ear. The vent consists of an outer titanium tube that osseointegrates with the mastoid bone and an inner Teflon tube that protrudes into the mastoid antrum. OBJECTIVE: To follow up all patients who had the mastoid vent inserted since 1995. STUDY DESIGN AND SETTING: Retrospective study of 14 patients with mastoid vents inserted at the ear, nose, and throat clinic of a district general hospital. PATIENTS: All patients had ventilation problems of the ear that failed to respond to conventional treatment. Three patients had persistent otitis media with effusion; 10 had completely collapsed eardrums; and 1 had failed tympanoplasty with recollapsed eardrum. INTERVENTION AND OUTCOME MEASURE: The mastoid vent extrusion rate, surrounding skin reaction, patency of the vent, and functional results were assessed with a follow-up period of 9 to 36 months. RESULTS: Only 1 vent was extruded in a patient who had a previous cortical mastoidectomy. There was no dermatitis around any of the vents. All vents remained patent, and 9 of the 14 ears underwent successful ventilation. Four ears had adhesions within the mastoid antrum, mainly due to a previous cortical mastoidectomy. Six of 8 ears with intact ossicles also had improved hearing. CONCLUSION: The percutaneous mastoid vent can provide medium-term ventilation to the middle ear.     

胆脂瘤型和骨疡型中耳炎Ⅰ期鼓室成形术的疗效观察

目的：探讨胆脂瘤型和骨疡型中耳炎Ⅰ期鼓室成形术的可行性及疗效影响因素。方法：52例(52耳)慢性化脓性中耳炎(胆脂瘤型30耳，骨疡型22耳)患者在清除病变的同时行鼓室成形术，其中单纯鼓室成形术12耳，乳突根治加鼓室成形术40耳。结果：全部病例均干耳，无一例胆脂瘤复发。语频段听力提高30dB以上者5耳，提高20～29dB者9耳，提高10～19dB者31耳，小于10dB者7耳，无听力下降者。结论：胆脂瘤型和骨疡型中耳炎可行Ⅰ期鼓室成形术，鼓膜有效振动面积、镫骨及镫骨底板的活动度是影响听力的重要因素，咽鼓管功能不良是手术失败的主要原因。     

筋膜外植法鼓室成形术的手术体会

目的 探讨筋膜外植法在鼓室成形术中的应用及价值.方法 回顾分析筋膜外植法鼓室成形术63耳,随访观察患者的外耳道宽敞度、鼓膜形态及听力恢复情况.结果 本组病例包括中耳胆脂瘤25耳,慢性化脓性中耳炎38耳.手术方式分别为筋膜外植法鼓室成形术、筋膜外植法鼓窜成形术+完肇式乳突根治术和筋膜外植法鼓室成形术+开放式乳突根治术三种类型,中耳胆脂瘤和慢性化脓性中耳炎患者实施三种手术的数最分别为4、17、4耳和19、18、1耳.术后切口全部Ⅰ期愈合.随访0.5～3.5年,外耳道宽敞,鼓膜形态良好,听力提高或维持术前水平,未有听力下降者.按时随访者未发现有明显并发症.结论 筋膜外植法鼓室成形术具有操作流程规范、术野暴露充分、病变清除彻底等优点,在慢性中耳炎的外科治疗中具有积极意义.     

Bone cement ossiculoplasty: incus to stapes versus malleus to stapes cement bridge.

OBJECTIVE: In this study, our purpose was to evaluate results of our experience with bone cement repair of ossicular discontinuity between the incus and stapes and between the malleus and stapes. METHODS: Medical records of patients who underwent surgery for chronic otitis media between March 2000 and December 2002 were evaluated retrospectively. Fifty-seven patients who underwent bone cement ossiculoplasty and had appropriate follow-up data were included in the study. Bone cement reconstruction of the ossicular chain was performed 1) from incus to stapes (I-S) in the absence of long arm or lenticular process of the incus and 2) from malleus to stapes (M-S) in the absence of the incus. The clinical data of the patients were evaluated by otoscopic examination and audiometry. RESULTS: The graft take rate was 84.1%. I-S procedure was performed in 42 and M-S in 8 patients. Pre- and postoperative PTAs of all patients were compared, which showed a significant improvement in air PTA (p < 0.001) while bone PTA did not change (p > 0.05). In I-S and M-S groups, successful hearing restoration could be achieved in 78.6.1% and 87.5% of the patients, respectively. Hearing results of different aural pathologies (chronic otitis media and conductive hearing loss) and surgeries (tympanotomy and tympanoplasty with or without mastoidectomy) were not significantly different (p > 0.05). CONCLUSION: Bone cement ossiculoplasty offers cost effective and significant improvement in conductive hearing loss.     

Tympanoplasty, with or without mastoidectomy, is highly effective for treatment of chronic otitis media in children

CONCLUSION: The overall success rate of tympanoplasty, with or without mastoidectomy, in the treatment of chronic pediatric otitis media, was high and did not depend on patient age, the status of the contralateral ear, the inclusion or absence of surgical mastoidectomy, or the method of mastoidectomy (when this procedure was employed). Tympanoplasty may be expected to improve hearing in cases of chronic otitis media accompanied by perforation, but not in cases of cholesteatoma. OBJECTIVES: This study analyzed the clinical features of pediatric patents with chronic otitis media undergoing tympanoplasty, with or without mastoidectomy. Follow-up data were examined to determine the effectiveness of these procedures on the course of the patients' conditions. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 111 children (a total of 119 ears were treated from this group) aged 15 years or less, who underwent surgical treatment for pediatric chronic otitis media. The subjects were composed of children suffering from chronic otitis media with perforation (COMP) (63 ears), and patients presenting chronic otitis media with cholesteatoma (COMC) (56 ears). The mean follow-up period was 40 months. Preoperative and postoperative (at the final follow-up) audiometry and otologic examinations were performed. Data from postoperative otologic examinations and audiometric measurements were accompanied by examination of both the operative ear and the contralateral ear. Surgical success was defined as the presence of an intact tympanic membrane without perforation, retraction, or evidence of recurring cholesteatoma. RESULTS: The mean ages at the time of operation were 11.1+/-3.3 years for COMP patients and 9.7+/-3.0 years for COMC subjects. Surgical treatments for pediatric COMP and COMC patients included tympanoplasty only in 45 ears (38% of ears treated) and tympanoplasty with mastoidectomy in 74 ears (62%). Most of patients with COMC received tympanoplasty with mastoidectomy. No patient with COMP underwent canal wall-down mastoidectomy. Mean pre-operative air-bone gaps (ABGs) and post-operative ABGs were compared. Significant improvement in ABG was evident in the COMP group, but not in the COMC group. Surgical success rates at follow-up after 6 months and 12 months were 97% and 95%, respectively, in the COMP group. In the COMC patients, surgical success rates at follow-up after 6 months and 12 months were 98% and 93%. There were no significant relationships between surgical success rate and patient age, the status of the contralateral ear, or the extent of surgery.     

Results of surgical treatment for chronic noncholesteatomatous otitis media in the pediatric population.

The long-term results of surgery for chronic otitis media without cholesteatoma were analyzed in 76 ears of children aged 16 years or less. The mean follow-up period was 6.0 years. Thirty-four ears were subjected to mastoid surgery for chronic otorrhea; at final follow-up examination the disease was found to be cured in all but one patient. Forty-two patients with sequelae to chronic otitis media underwent tympanoplasty without mastoidectomy which was successful in 38 (91%) of these. At follow-up, 84% of the patients had hearing levels of 20 dB or better. Outcome of surgery and hearing results in children were as good as or even better than those obtained in adult patients. Complications of surgery were rare.     

Role of aerating mastoidectomy in noncholesteatomatous chronic otitis media

OBJECTIVE: To assess the success rate of revision tympanoplasty with aerating mastoidectomy in patients with noncholesteatomatous chronic otitis media who had failed at least one prior tympanoplasty. STUDY DESIGN: Retrospective chart review. METHODS: Data were analyzed from 135 patients available for clinical and audiometric studies with a minimum of 18 months' follow-up. All patients had failed at least one prior tympanoplasty and presented with: 1) a persistent tympanic membrane perforation with intermittent drainage, or 2) a wet draining ear, unresponsive to systemic antibiotic and topical management. All patients underwent 1.5-mm, high-density, bone window computed tomography (CT) scanning to assess middle ear, epitympanic, and mastoid air cell pneumatization. All patients underwent revision tympanoplasty with aerating mastoidectomy via a postauricular approach. Patient charts were reviewed for information regarding preoperative radiographic findings, mucosal and ossicular findings at the time of surgery, and success or failure of revision tympanomastoidectomy. RESULTS: The tympanic membrane graft take rate for the entire group of 135 patients was 90.4% (13 grafts failed). A majority of the patients were found to have radiographic and intraoperative evidence of middle ear/mastoid disease. CONCLUSION: For patients with noncholesteatomatous chronic otitis media who have failed prior tympanoplastic reconstruction, an aerating mastoidectomy may be indicated and may improve the success rate of the surgery.     

慢性中耳炎手术方法的选择

目的 探讨慢性中耳炎中耳乳突手术方式选择的依据.方法对160耳慢性中耳炎患者依据术前的高分辨CT（high resolution computed tomography,HRCT）检查并参考听力学,分别选择了鼓室成形术、一期乳突病变切除加鼓室成形术.结果依据术前HRCT检查,中耳乳突未发现阴影31耳行鼓室成形术,中耳乳突部分有阴影49耳行乳突病变切除加鼓室成形术（完壁式）,中耳乳突弥漫阴影或有骨破坏80耳行（开放式）乳突病变切除加鼓室成形术.术后干耳时间：7天～51天,平均23天.术后听力平均提高15 dB.结论160例慢性中耳炎手术方法的选择,主要以术前的HRCT为参考依据.     

Subjective and objective outcomes of tympanoplasty surgery at National Hospital Abuja, Nigeria 2005�C2009

The objective of this study is to determine the subjective and objective outcomes of tympanoplasty surgery carried out in patients with otitis media and to identify factors responsible for these outcomes. The study setting is tertiary care urban referral hospital in a developing economy and the study methodology is a prospective analysis of patients with diagnosis of chronic suppurative otitis media that had tympanoplasty with or without mastoidectomy between May 2005 and September 2009 at National Hospital Abuja. Subjects were evaluated for age, sex, size and site of perforation, status of operated ear(s) (dry/discharging), status of the contralateral ear, surgical technique, subjective and objective pre-operative and post-operative hearing scores, average post-operative follow-up time, and post-operative complications, and results were statistically analyzed. A total of 45 patients (51 ears) were operated. Age distribution was 8?C52?years. Type 1 tympanoplasty was done in 41 patients and Type 3 in 4 patients. Seven of the patient had concomitant mastoid surgery (cortical mastoidectomy). 3/51 of the cases had discharging ears at surgery. 16/45 of the patients (19/51 ears) had cartilage graft tympanoplasty, while 29/45 (32 ears) had temporalis fascia tympanoplasty. 15/16 of the cartilage group as well as 26/29 of the fascia group reported subjective hearing improvement, whilst the actual graft take was 12/16 of the cartilage group and 23/29 of the fascia group. Objective hearing improvement was observed in all of the cartilage as well as 26/29 of the fascia group. This study confirms success of tympanoplasty among Nigerians, and recommends that subjective hearing assessment should form part of indicators for success following tympanoplasty.     

中耳胆脂瘤和慢性化脓性中耳炎手术临床分析

目的　探讨中耳胆脂瘤和慢性化脓性中耳炎术式选择及临床效果。方法　对110例中耳乳突病变,包括中耳胆脂瘤和慢性化脓性中耳炎,根据范围显微镜下实施完壁式或开放式乳突根治,部分同时鼓室成形术,随访术后干耳状况、并发症、复发情况以及术后听力改善程度等。结果　110例患者中66例中耳胆脂瘤、44例慢性化脓性中耳炎,出现颅内外并发症者7例。手术方式：51例（46.36%）行完壁式乳突根治术,46例（41.81%）同时行鼓室成形术,59例（53.64%）行开放式乳突根治术。完壁式乳突根治术后听 力提高＞25 dB 37例（33.64%）,＞15 dB 14例（12.72%）;开放式乳突根治术后听力提高＞15 dB 5例（4.55%）,听力减退4例（3.64%）,比较手术前后言语频率区平均听阈,差异有统计学意义（P＜0.05）。术后随访1年发现开放式和完壁式两组胆脂瘤复发共4例。结论　中耳胆脂瘤与慢性化脓性中耳炎通过选择恰当手术方式可获得较好的临床疗效。     

Over-under tympanoplasty

OBJECTIVE: Common techniques of tympanic membrane repair include underlay and overlay grafting. The over-under tympanoplasty, an innovative method for tympanic membrane repair, will be described as a reliable alternative that has advantages over traditional procedures. STUDY DESIGN: This study was a retrospective case review. SETTING: Tertiary referral center with hospital-setting surgery and outpatient ambulatory patient visits. PATIENTS: One hundred twenty patients who underwent over-under tympanoplasty were included in this study. Average follow-up was 1.8 years. INTERVENTION: Over-under tympanoplasty is performed by placing the graft over the malleus and under the annulus. This technique was used for patients undergoing ear surgery for chronic otitis media, perforations, cholesteatoma, and/or conductive hearing loss. All degrees of ear pathology were included. MAIN OUTCOME MEASURES: Main outcome measures were graft success (no perforation, atelectasis, or lateralization within 6 mo) and improvement of hearing. Patients were stratified by severity of disease (according to the Middle Ear Risk Index), cholesteatoma presence, and type of mastoidectomy. RESULTS: All 120 patients had successful grafts. Lateralization of the grafted drum did not occur. Seventeen patients had late atelectasis, and 12 patients had late perforations; nearly all of these were noted more than 1 year after surgery and were attributed to persistent eustachian tube dysfunction or infections. Average improvement in air-bone gap for all patients was 5.3 dB, whereas speech reception threshold improved by 5.9 dB. CONCLUSION: Over-under tympanoplasty has an excellent success rate while being technically easier than lateral tympanoplasty. Thus, it is a useful method for practitioners of all levels.     

中耳炎手术中后鼓室病灶的处理

目的:分析中耳炎手术治疗中后鼓室病灶处理的疗效。方法:资料完整的慢性中耳炎168例,66例单纯行病灶清除术,102例行病灶清除及鼓室成形术。鼓室成形术中,22例行不伴乳突凿开的鼓室成形术,53例行乳突径路鼓室成行术,27例行乳突根治并鼓室成形术。术中均探查后鼓室并仔细对该处病灶进行清理,用自体骨组织行鼓室成形术。结果:均随访1年以上,168例中获得干耳160例,8例未干耳或复发,其中骨疡型3例,胆脂瘤型5例。单纯病灶清除术患者复发1例,病灶清除及鼓室成形术患者复发7例,手术有效率为95%;鼓室成形术后平均听力提高>15dB 87例(85%)。结论:中耳炎手术中,无论采取何种手术方式及径路,都应仔细探查后鼓室,并对病灶进行清除,从而提高手术疗效。     

保留低位骨桥的开放式乳突根治并鼓室成形术65例临床分析

目的 回顾性分析近期本人施行的65例保留低位骨桥的开放式乳突根治鼓室成型手术。方法 回顾分析2003年1月-2004年3月本人实施的65例保留低位骨桥的开放式乳突根治鼓室成型手术病例，其中胆脂瘤型中耳炎41例．骨疡型中耳炎24例介绍其手术方法并对术后干耳率及听力提高情况进行了统计分析。结果所 有病人均获干耳．鼓膜愈合良好，无明显内陷。干耳时间约为1—3个月，术后随访1年，无一例胆脂瘤或中耳炎复发。干耳后的听力恢复较满意。平均气骨导差缩小在10dB以上共占83．6％，其中10—20dB占38．2％，20—30dB占30．5％，〉30dB者14．9％。结论 保留低位骨桥的开放式乳突根治术在治疗胆脂瘤型或严重骨疡型中耳炎中既能保证彻底清除病变又能最大限度提高患耳的听力．是治疗这类疾病一种较好的手术方法。     

Analysis on the correlation between Eustachian tube function and outcomes of type I tympanoplasty for chronic suppurative otitis media

Abstract

Background: The potential influence of Eustachian tube dysfunction (ETD) on the efficacy of tympanoplasty is controversial.

Objective: This study aims to investigate the correlation between Eustachian tube function (ETF) and outcomes of type I tympanoplasty for chronic suppurative otitis media (CSOM).

Materials and Methods: 53 patients with CSOM and receiving type I tympanoplasty were divided into a dysfunction group (Eustachian tube score; ETS ≤ 5points) and a normal group (ETS > 5 points) according to their preoperative ETS. During the one-year follow-up, the ETS, hearing results, and eardrum condition of the patients were recorded and analyzed.

Results: The ETS improved significantly from 2.57 (±1.73SD) to 4.68 (±2.00SD), while the mean air–bone gap (ABG) decreased significantly from 20.94 (±9.04SD) dB to 16.43 (±9.06SD) dB in the dysfunction group (p?<?.05). The postoperative ABG showed no significant difference in the two groups. The healing rate of the tympanic membrane was 96.43% in the dysfunction group, and 100% in the normal group.

Conclusions and significance: The ETF was significantly improved after type I tympanoplasty for CSOM combined with ETD, and the postoperative efficacy was not adversely affected. The ETD may not influence the outcomes of type I tympanoplasty for CSOM.     

Subannular ventilation tubes: retrospective study

OBJECTIVE: To evaluate the efficiency of a subannular tube insertion technique in a group of pediatric patients with adhesive otitis or severe atelectasis of the tympanic membrane. DESIGN: Retrospective nonrandomized case series. Setting: Tertiary referral centre. MAIN OUTCOME MEASURES: The main outcomes of this study are tube duration according to the type of tube used, the complication rate, and the audiometric gain associated with this procedure. RESULTS: The study group consisted of 190 patients (316 tubes) aged between 3 and 19 years (average 9 years old) and operated on between 1993 and 1999 by four pediatric otolaryngologists. The average follow-up was 53 months. The tubes remained in place for an average of 21.8 months, with fluoroplastic tubes lasting 17.8 months and Goode T tubes lasting 23.8 months. When used in children between 5 and 9 years of age and in cases of adhesive otitis, Goode T tubes showed statistically significantly better results than fluoroplastic tubes. The complications of this technique were otorrhea (17.7%), perforation (7.9%), a plugged tube (7.0%), and cholesteatoma (1.6%). The 5- to 9-year-old group and the reintervention group of patients showed statistically higher complication rates compared with all other groups. Sixty-four patients (128 tubes) were eligible for audiogram analysis, which showed a gain of 13.4 dB (speech reception threshold). CONCLUSIONS: The technique of subannular tube insertion is a safe and effective method for long-term middle ear ventilation in cases of adhesive otitis or severely atelectatic tympanic membrane or for patients with pathology related to dysfunction of the eustachian tube. It offers an alternative to repeated short-term tube insertions for otitis media with effusion or recurrent acute otitis media.     

The Yung percutaneous mastoid vent: results of a multicenter trial.

OBJECTIVE: The primary goal of the study was to find out whether the Yung vent would remain patent long-term. The secondary goal was to find out whether mastoid ventilation could overcome permanent ventilation disorder within the middle ear. STUDY DESIGN: The study was an open prospective investigation. SETTING: The study was a multicenter study involving three tertiary referral centers. PATIENTS: Twenty-three subjects older than 12 years were included. The inclusion criteria were complete atelectasis, failed tympanoplasty because of persistent eustachian tube dysfunction, and persistent otitis media with effusion in spite of repeated ventilation tube insertion. INTERVENTION: Tympanoplasty with insertion of the Yung percutaneous mastoid vent. MAIN OUTCOME MEASURES: Patency of the vent, adverse effects, patient acceptance, hearing results, and appearance of the tympanic membrane were assessed every 3 months up to 18 months postoperatively. RESULTS:: At 18 months, 20 of 23 vents were still patent. Overall, there had been no unacceptable adverse effect on any patient. Eighteen of 23 ears had improved hearing. The tympanic membrane had returned from a collapsed state to near normal in 13 of 17 completely atelectatic ears. There were five patients who had no benefit from the vent because of blockage within the epitympanum or middle ear effusion. CONCLUSION: The Yung percutaneous mastoid vent can maintain long-term patency. It is effective in the treatment of complete atelectasis as an adjunct to tympanoplasty.     

Surgical management of only hearing ears with positive indications

Positive surgical indications for an only hearing ear were evaluated in order to improve patients' quality of life. Fifteen cases of surgery involving an only hearing ear over the past eight years were retrospectively reviewed. Of eight perforated chronic otitis media cases, seven underwent type one tympanoplasty and one underwent simple underlay myringoplasty regardless of otorrhoea at the time of surgery. Of six cholesteatoma cases, two received the canal wall up method and four received the canal wall down method. Ossiculoplasty was carefully performed in six cases. Hearing was improved in seven cases, whereas it remained unchanged in seven cases and deteriorated in one case. Of nine patients, two did not need a hearing aid after surgery. Five patients with severe combined hearing loss (>90 dB) were able to communicate with a hearing aid, alleviating their anxiety regarding hearing loss. Only hearing ears with chronic otitis media and cholesteatoma can be successfully treated by tympanoplasty with or without ossiculoplasty.     

Success of cartilage grafting in revision tympanoplasty without mastoidectomy.

OBJECTIVE: Candidates for revision tympanoplasty have experienced at least one failed attempt at repair of the tympanic membrane and are, therefore, at higher risk for subsequent repair failure. The adjunctive use of mastoidectomy with tympanoplasty in those patients with noncholesteatomatous chronic otitis media is often used to decrease the risk for subsequent failure. However, at this institution, where we use cartilage tympanoplasty, mastoidectomy is rarely performed in the absence of cholesteatoma. Our objective was to assess outcomes in patients undergoing revision tympanoplasty without mastoidectomy using cartilage grafting. STUDY DESIGN: We conducted a retrospective case review. SETTING: Tertiary referral center. PATIENTS: A total of 95 patients (42 female, 53 male; 5-81 yr of age) with a recurrent perforation who were treated surgically with cartilage tympanoplasty without mastoidectomy were included in the chart review. Patients must have undergone at least one previous tympanoplasty without mastoidectomy and had to have complete audiologic and chart follow up. INTERVENTIONS: An underlay tympanoplasty technique using either a tragal cartilage-perichondrium island graft or palisaded concha cymba cartilage was used. Ossiculoplasty was performed as needed. MAIN OUTCOME MEASURE: Main outcome measures were incidence of reperforation of the grafted tympanic membrane, hearing result, and prevalence of other complications. RESULTS: Successful closure without reperforation was obtained in 90 of 95 patients (94.7%). Average postoperative pure-tone average air-bone gap was 12.2 +/-7.3 dB compared with 24.6+/-13.8 dB preoperatively (p <0.001). CONCLUSIONS: Revision tympanoplasty with cartilage provided equivalent results to tympanoplasty with mastoidectomy. Thus, mastoidectomy may not be necessary in revision tympanoplasty in the absence of cholesteatoma if the repair is made with cartilage.     

乳突切除术治疗分泌性中耳炎

目的：探讨乳突切除术治疗分泌性中耳炎的疗效。方法：回顾性分析22例（24耳）行乳突切除手术的分泌性中耳炎患者,其中行完壁式并面隐窝开放手术20耳,开放式手术4耳,同期行鼓膜切开置管术3耳。术后6个月拔管,测试术前、术后的听力。结果：所有患者术后均未出现听力下降,19耳有不同程度的听力提高,鼓室导抗图为A型曲线者17耳,C型曲线者7耳。术后随访6-36个月,未见中耳炎复发。结论：对反复发作、长期迁延经治疗无效的分泌性中耳炎,乳突切除术可改善乳突、鼓窦、鼓室和咽鼓管的通气引流,减少分泌性中耳炎的复发。     

鼓膜紧张部中央性大穿孔患者中耳乳突病变的特点及处理

目的:探讨慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部中央性大穿孔患者的病变特点及处理方法。方法:慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部中央性大穿孔患者147例,其中101例不伴乳突病变者行鼓室成形术;46例伴乳突病变者,在进行鼓室成形术的同时进行乳突开放术。结果:147例中有142例(96.6%)一期愈合。术后3个月纯音听力骨气导差平均为(16.6±10.9)dBHL。结论:慢性化脓性中耳炎(单纯型,静止期)伴鼓膜紧张部大穿孔的患者,术前颞骨高分辨CT检查及术中详细探查是必须的。确保术后咽鼓管、上鼓室、鼓窦,特别是后两者的引流通畅是提高疗效的关键。应用软骨软骨膜复合物行鼓膜重建或上鼓室、后鼓室及鼓膜的联合重建,对鼓膜紧张部中央性大穿孔的患者不失为一种切实可行的治疗方法。